Healthcare Provider Details

I. General information

NPI: 1306837224
Provider Name (Legal Business Name): LISA K URBANC RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N16088 US 2-41
SPALDING MI
49886-0155
US

IV. Provider business mailing address

W5080 HANBURY LAKE RD
VULCAN MI
49892-8989
US

V. Phone/Fax

Practice location:
  • Phone: 906-497-5516
  • Fax: 906-497-4206
Mailing address:
  • Phone: 906-563-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: